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Wearable sensors enable personalized predictions of clinical laboratory measurements

Nature Medicine volume 27, pages 1105–1112 (2021)Cite this article

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Abstract

Vital signs, including heart rate and body temperature, are useful in detecting or monitoring medical conditions, but are typically measured in the clinic and require follow-up laboratory testing for more definitive diagnoses. Here we examined whether vital signs as measured by consumer wearable devices (that is, continuously monitored heart rate, body temperature, electrodermal activity and movement) can predict clinical laboratory test results using machine learning models, including random forest and Lasso models. Our results demonstrate that vital sign data collected from wearables give a more consistent and precise depiction of resting heart rate than do measurements taken in the clinic. Vital sign data collected from wearables can also predict several clinical laboratory measurements with lower prediction error than predictions made using clinically obtained vital sign measurements. The length of time over which vital signs are monitored and the proximity of the monitoring period to the date of prediction play a critical role in the performance of the machine learning models. These results demonstrate the value of commercial wearable devices for continuous and longitudinal assessment of physiological measurements that today can be measured only with clinical laboratory tests.

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Fig. 1: Overview of the iPOP wearables study.
Fig. 2: Methodology for predicting clinical laboratory measurements from vital signs collected using wearables.
Fig. 3: Predicting clinical laboratory measurements from vital signs collected using wearables.
Fig. 4: Relationship between duration and proximity of monitoring and model accuracy.
Fig. 5: Personalized models improve predictions of clinical laboratory tests from vital sign measurements.

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Data availability

Intel Basis watch data are available on the Stanford iPOP site (http://ipop-data.stanford.edu/wearable_data/Stanford_Wearables_data.tar) and in the Digital Health Data Repository48 (https://github.com/DigitalBiomarkerDiscoveryPipeline/Digital_Health_Data_Repository/tree/main/Dataset_StanfordWearables). Data that are unique to this study are included as source data and in the supplementary tables. Source data are provided with this paper.

Code availability

R version 3.3.3 was used with the base packages and the following additional CRAN packages: stats, glmnet, lme4, randomForest and PMA. Custom scripts were used for data analysis and are open source via github.com/jessilyn/wearables_vitalsigns (https://doi.org/10.5281/zenodo.4661493), and wearables data pre-processing scripts are available on the Digital Biomarker Discovery Pipeline (https://DBDP.org)48.

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Acknowledgements

The work was supported by grants from the National Institues of Health (NIH) Common Fund Human Microbiome Project (HMP) (1U54DE02378901), an NIH National Center for Advancing Translational Science Clinical and Translational Science Award (UL1TR001085), and the Chan Zuckerberg Initiative Donor-Advised Fund (an advised fund of Silicon Valley Community Foundation; 2020-218599). JD, LK, RR and JH were supported by the Mobilize Center grant (NIH U54 EB020405). SMS-FR was supported by an NIH Career Development Award (no. K08 ES028825). JD is a MEDx Investigator and a Whitehead Scholar. The Stanford Translational Research Integrated Database Environment (STRIDE) is a research and development project at Stanford University that aims to create a standards-based informatics platform supporting clinical and translational research. We thank the participants who generously gave their time and biological samples for this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Department of Veteran Affairs.

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Author notes

  1. These authors contributed equally: Jessilyn Dunn, Lukasz Kidzinski

Authors and Affiliations

  1. Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA

    Jessilyn Dunn, Ryan Runge, Sophia Miryam Schüssler-Fiorenza Rose, Xiao Li, Amir Bahmani & Michael P. Snyder

  2. Department of Biomedical Engineering, Duke University, Durham, NC, USA

    Jessilyn Dunn & Daniel Witt

  3. Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA

    Jessilyn Dunn & Daniel Witt

  4. Department of Bioengineering, Stanford University, Stanford, CA, USA

    Jessilyn Dunn, Lukasz Kidzinski, Ryan Runge, Jennifer L. Hicks & Scott L. Delp

  5. Stanford Cardiovascular Institute, Stanford, CA, USA

    Jessilyn Dunn, Sophia Miryam Schüssler-Fiorenza Rose & Michael P. Snyder

  6. Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA

    Sophia Miryam Schüssler-Fiorenza Rose

  7. Department of Biochemistry, The Center for RNA Science and Therapeutics, Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH, USA

    Xiao Li

  8. Department of Mechanical Engineering, Stanford University, Stanford, CA, USA

    Scott L. Delp

  9. Department of Statistics, Stanford University, Stanford, CA, USA

    Trevor Hastie

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Contributions

J.D., L.K., T.H. and M.P.S. conceived and designed the study; J.D., L.K., J.H., T.H., M.P.S. and S.D. carried out the methods; J.D., R.R., X.L. and A.B. curated the data; J.D., L.K., R.R. and D.W. analyzed the data; J.D., L.K., J.H., S.M.S.-F.R. and M.P.S. wrote the manuscript; and M.P.S., S.D. and J.D. obtained funding.

Corresponding authors

Correspondence to Jessilyn Dunn, Trevor Hastie or Michael P. Snyder.

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Competing interests

M.P.S. is a cofounder of Personalis, SensOmics, Qbio, January AI, Filtricine, Protos, and NiMo, and is on the scientific advisory board of Personalis, SensOmics, Qbio, January AI, Filtricine, Protos, NiMo, and Genapsys. All other authors have no competing interests.

Additional information

Peer review information Nature Medicine thanks Hugo Aerts and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Michael Basson was the primary editor on this article and managed its editorial process and peer review in collaboration with the rest of the editorial team.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Extended data

Extended Data Fig. 1 Wearables temperature variations and extended modeling results.

a, Variations in wRTemp over course of the day. b, R statistics based on LOOCV for all tests from Fig. 3b. c, R statistics based on K-fold CV for all tests from Fig. 3b.

Extended Data Fig. 2 Model accuracy changes over time based on window of historical data from an individual.

a, Lasso regularized regression using features calculated using different windows of wearable device monitoring. b, Accuracy of the HCT cVS mixed effects models over time for two example patients that were monitored between 2.5–5 years at Stanford hospital with >50 HCT observations at separate clinic visits. The HCT cVS mixed effects models demonstrate that the model accuracy changes over time, and particularly with a dramatic health event like a myocardial infarction (ICD code I21.4) (red vertical line) or a life-threatening ED visit (blue vertical line; CPT code 99285).

Extended Data Fig. 3 Increasing amounts of personalized data open up new study and model possibilities.

a, Summary of different biomedical data collection modalities and the typical amount of data they result in. b, Demonstration of how the amount and modality of data collection (longitudinal continuous vs. discrete measurements) constrain the type and complexity of models that can be built from the data.

Supplementary information

Source data

Source Data Fig. 1

This file contains a table of data underlying Fig. 1d,e.

Source Data Fig. 3

This file contains a table of data underlying Fig. 3a,d.

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Dunn, J., Kidzinski, L., Runge, R. et al. Wearable sensors enable personalized predictions of clinical laboratory measurements. Nat Med 27, 1105–1112 (2021). https://doi.org/10.1038/s41591-021-01339-0

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